*Purpose: In 2017 the Organ Procurement and Transplantation Network (OPTN) altered US lung allocation policy by replacing the donor service area (DSA) with a 250 nautical mile (NM) circle around the donor hospital as the first unit of allocation for deceased donor lungs. Lung was the first system to remove DSA from allocation.

*Methods: OPTN data on lung candidates and recipients age &gt 11 was analyzed pre (5/28/2016- 11/24/2017) and post policy change (11/25/2017- 5/24/2019, 18 months). Cohorts were compared to study the differences.

*Results: There was an increase in match LAS at transplant from the pre era (N=1,806) to the post era (N=1,843) (mean pre=47.22 vs. post=49.82, p &lt 0.001) and increase in the distance from donor hospital to transplant center (median pre=112 NM vs. post=167 NM, p<0.001) with a corresponding decrease in within DSA transplants. There were no statistically significant changes in the waiting list mortality rate; however, overall and high LAS groups (60+) saw a slight decrease. There was a significant increase in the transplant rate for the 60-70 LAS group (pre= 405 (95% CI:324, 499) vs. post= 612 (95% CI:520, 716) transplants per 100 patient years) (fig1). The 70+ LAS group also saw an increase, but it was not significant. Six-month post-transplant survival remains stable (93.5% pre vs. 93.2% post). There was no change in the discard rate when excluding DCD and perfused lungs (pre=3.58 vs. post=3.81).

*Conclusions: Replacing DSA with a 250 NM circle in lung allocation has resulted in increased distance traveled from transplant center to donor hospital to provide transplants to sickest candidates. Early post-transplant outcomes have remained stable. Currently the OPTN Thoracic Transplantation Committee is working on converting lung allocation to align with the Continuous Distribution framework.

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